WALSTIR H FONSECA Medical Doctor License verification

Business Entity

EXPIRED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125028313

License Status

EXPIRED

Business

First Name

WALSTIR H

Last Name

FONSECA

Business Name

WALSTIR H FONSECA

Original Issue Date

05/22/1992

Effective Date

05/22/1992

Expiration Date

05/31/1995

City

URBANA

State

Zip

61801

County

CHAMPAIGN

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006